BNF for Children 2011-2012

BNFC 2011–2012 9.6.2 Vitamin B group 479Preterm neonates have low plasma concentrations ofvitamin A and are usually given vitamin A supplements,often as part of an oral multivitamin preparation (section9.6.7) once enteral feeding has been established.Massive overdose can cause rough skin, dry hair, anenlarged liver, and a raised erythrocyte sedimentationrate and raised serum calcium and serum alkalinephosphatase concentrations.Pregnancy In view of evidence suggesting that highlevels of vitamin A may cause birth defects, women whoare (or may become) pregnant are advised not to takevitamin A supplements (including tablets and fish-liveroil drops), except on the advice of a doctor or anantenatal clinic; nor should they eat liver or productssuch as liver paté or liver sausage.VITAMIN A(Retinol)Cautions see notes above; interactions: Appendix 1(vitamins)Pregnancy excessive doses can be teratogenic; seealso notes aboveBreast-feeding toxicity likely if mother taking highdosesSide-effects see notes aboveLicensed use preparations containing only vitaminA are not licensedIndication and doseSee also notes aboveVitamin A deficiency. By mouthNeonate 5000 units dailyChild 1 month–1 year 5000 units daily with orafter foodChild 1–18 years 10 000 units daily with or afterfoodNote Higher doses may be used initially for treatment ofsevere deficiencyPrevention of deficiency in complete biliaryobstruction. By intramuscular injectionNeonate 50 000 units once a monthChild 1 month–1 year 50 000 units once a monthArovit c (Non-proprietary)Oral solution, vitamin A 150 000 units/mLAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809Aquasol-A c (Non-proprietary)Injection, vitamin A (as palmitate) 50 000 units/mL,2-mL ampAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809VITAMINS A and DCautions see notes above and section 9.6.4; prolongedexcessive ingestion of vitamins A and D can lead tohypervitaminosis; interactions: Appendix 1 (vitamins)Pregnancy see notes aboveSide-effects see notes above and section 9.6.4Licensed use not licensed in children under 6months of ageIndication and doseSee notes above and section 9.6.4Prevention of vitamin A and D deficiency seeindividual preparations for dose informationVitamins A and DVitamins A and D (Non-proprietary)Capsules, vitamin A 4000 units, vitamin D 400 units.Net price 84 = £3.44Note May be difficult to obtainDoseChild 1–18 years 1 capsule dailyVitamins A, C and DHealthy Start Children’s Vitamin Drops (Non-proprietary)Oral drops, vitamin A 5000 units, vitamin D2000 units, ascorbic acid 150 mg/mLAvailable free of charge to children under 4 years in families on theHealthy Start Scheme, or alternatively may be available direct tothe public—further information for healthcare professionals canbe accessed at http://tinyurl.com/3yckebe. Beneficiaries cancontact their midwife or health visitor for further information onwhere to obtain supplies.DosePrevention of vitamin deficiency. By mouthChild 1 month–5 years 5 drops daily (5 drops containvitamin A approx. 700 units, vitamin D approx. 300 units,ascorbic acid approx. 20 mg)Note Healthy Start Vitamins for women (containing ascorbicacid, vitamin D, and folic acid) are also available free ofcharge to women on the Healthy Start Scheme duringpregnancy and until their baby is one year old, or alternativelymay be available direct to the public—further informationfor healthcare professionals can be accessed athttp://tinyurl.com/3yckebe. Beneficiaries can contact theirmidwife or health visitor for further information on where toobtain supplies.9.6.2 Vitamin B groupDeficiency of the B vitamins, other than vitamin B 12(section 9.1.2), is rare in the UK and is usually treated bypreparations containing thiamine (B 1 ), and riboflavin(B 2 ). Other members (or substances traditionally classifiedas members) of the vitamin B complex such asaminobenzoic acid, biotin, choline, inositol, and pantothenicacid or panthenol may be included in vitamin Bpreparations, but there is no evidence of their value assupplements; however, they can be used in the managementof certain metabolic disorders (section 9.8.1).Anaphylaxis has been reported with parenteral B vitamins(see MHRA/CHM advice, below).As with other vitamins of the B group, pyridoxine (B 6 )deficiency is rare, but it may occur during isoniazidtherapy (section 5.1.9) or penicillamine treatment inWilson’s disease (section 9.8.1) and is characterised byperipheral neuritis. High doses of pyridoxine are givenin some metabolic disorders, such as hyperoxaluria,cystathioninuria and homocystinuria; folic acid supplementationmay also be beneficial in these disorders9 Nutrition and blood